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DHHS
OIG APPROVES COST SAVINGS SHARING ARRANGEMENT BETWEEN SURGEONS AND HOSPITAL
In Advisory Opinion No. 05-01 released on February
4, the DHHS Office of Inspector General (OIG) said a proposal by a hospital
to share with a group of cardiac surgeons a percentage of the hospital’s
cost savings arising from the surgeons’ implementation of cost reduction
measures for certain surgical procedures could potentially generate prohibited
remuneration under the Anti-Kickback Statute, but that it would not impose
administrative sanctions in connection with the arrangement.
To read the Advisory Opinion, go to www.healthlawyers.org/docs/ask2005/AO_0501.pdf.
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CONGRESS SHOULD EXTEND
SPECIALTY HOSPITAL MORATORIUM PENDING FURTHER REVIEW, MedPAC Advises
Congress should extend the current moratorium on the development
of new specialty hospitals through January 1, 2007, the Medicare Payment
Advisory Commission (MedPAC) recommended in its latest report on the issue.
MedPAC said the extension is needed to allow further study on the effect
of these limited service facilities. At the same time, MedPAC also recommended
changes to the way Medicare reimburses hospitals for inpatient services “to
improve the accuracy of the recommended changes to the way Medicare reimburses
hospitals for inpatient services “to improve the accuracy of the payment
system and thus reduce opportunities for hospitals to benefit from selection.
Meanwhile, the House Ways and Means Subcommittee on Health and the Senate
Finance Committee held hearing on the specialty hospital issue at which Senate
Finance Committee Ranking Minority Member Max Baucus (D-MT) expressed concern
that “when it comes to physician ownership of speciality hospitals,
I’m not sure the playing field is level.” For more information
on the Senate finance Committee hearing, go to http://www.finance.senate.gov/sitepages/hearing030805.htm.
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DOJ
OFFERS GUIDANCE ON NONDISCRIMINATION AGAINST
LIMITED ENGLISH SPEAKERS
The Civil Rights Division of the U.S. Department of Justice issued guidance
October 26 on what recipients of federal assistance-including hospitals-must
do to ensure they are not discriminating against those with limited English
proficiency.
The guidance is online at www.usdoj.gov/crt/cor/lep/Oct26Memorandum.htm.
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CMS PUBLISHES NATIONAL PROVIDER
IDENTIFIER FINAL RULE
On January 23, 2004 CMS published the long awaited National Provider Identifier
(NPT) final rule. This NPT final rule requires all health care organizations
to use an assigned identifier for each health care provider when filing and
processing electronic claims and other standard transactions.
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ALJ UPHOLDS FTC'S COMPLAINT AGAINST
PHYSICIANS GROUP FOR PRICE FIXING
In an initial decision announced November 16, an Administrative Law Judge
(ALJ) upheld the Federal Trade Commission's (FTC's) complaint against a physicians
group alleging that the group conspired to fix prices in certain contacts
its doctors entered into to provide medical services to the patients of health
plans.
For more information go to www.ftc.gov/opa/2004/11/northtexas.htm
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FTC Settles
with Physicians Group on Price-Fixing Charges
The Federal Trade Commission (FTC) announced April 5 it has reached a settlement
with a Chicago-area physicians group. Evanston Northwestern Healthcare Corporation
(ENH) and ENH Medical Group, Inc. (ENH Medical Group), whereby the group
has agreed to put an end to collective bargaining on behalf of its members.
According to FTC,ENH Medical Group "violated Section 5 of the FTC Act by
facilitating and implementing agreements among rival physicians to fix prices
and other terms of dealing with health plans and other third-party payors,
and by refusing to deal with such payors except on jointly determined terms."
To read FTC's press release go to www.ftc.gov/opa/2005/04/050405evanston.htm.
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OIG ADDRESSES GAIN-SHARING
ARRANGEMENTS IN RECENT ADVISORY OPINIONS
In February 2005, the U.S. Department of Health and Human Services Office
of Inspector General (OIG) released a series of Advisory Opinions that provide
guidance to hospitals on structuring gain-sharing arrangements with physicians.
The opinions mark the latest in a series of OIG pronouncements on gain-sharing
over the last several years. While the opinions continue to express the OIG’s
longstanding view that such arrangements could lead to reductions in care
and allow hospitals to generate kickback type payments to physicians, the
opinions also reveal that gain-sharing arrangements containing certain features
will not be subject to enforcement action by the OIG.
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